The Social History - Coggle Diagram
The Social History
Includes personal history and lifestyle choices
Patients are more than their medical diagnoses
Relationships and support system
"who would you say is your support system
Ask about partners, kids, friends, etc.
Beware of intimate partner violence
Kaiser Family Foundation site
Peaceful Paths in Gainesville
Ask about how life was growing up
Time off for health?
How far did they go in school?
The reliability of their report is influenced by the situation
Your own comfort/anxiety about it
Their anxiety/comfort talking about these
How questions are phrased
Addressing patient's anxiety
Normalizing - let them know that it's ok to feel anxious, etc. about these questions
Transparency - Let them know why you are asking
Example: I ask all of my patients about this because it affects their overall health. Can I ask you...
**Start with closed ended questions because that way they aren't putting themselves in an awkward situation
Ask for facts, not judgements
Substance use questions
Have you ever used?
4 or more a day or 8/week for women
5/day for men or >15/week
Use the CAGE questions (also can use for recreational drug use and tobacco
Have you felt you should Cut down on drinking?
Have people Annoyed you by criticizing you drinking?
Have you ever felt bad or Guilty about your drinking?
Have you ever had a drink in the morning (Eye opener) to steady your nerves or get over a hangover?
Smoking: Packs per day * years smoked = pack years
Health related behaviors
Be curious, not judgmental
You can ask about religion/spirituality (Important)
Much of the time the social history info is taken via intake forms
Trust, but verify
Opening the interview
greet by name and ask about method of address
Introduce self and purpose
What's the present?
What's the past?
How do you feel about it?
Do you have any other concerns?
"Be prepared to tell me at least one thing about your patient that no one else knows." Dr. Lynch